TY - JOUR
T1 - Phase I Trial of Stereotactic MRI-Guided Online Adaptive Radiation Therapy (SMART) for the Treatment of Oligometastatic Ovarian Cancer
AU - Henke, Lauren E.
AU - Stanley, Jennifer A.
AU - Robinson, Clifford
AU - Srivastava, Amar
AU - Contreras, Jessika A.
AU - Curcuru, Austen
AU - Green, Olga L.
AU - Massad, L. Stewart
AU - Kuroki, Lindsay
AU - Fuh, Katherine
AU - Hagemann, Andrea
AU - Mutch, David
AU - McCourt, Carolyn
AU - Thaker, Premal
AU - Powell, Matthew
AU - Markovina, Stephanie
AU - Grigsby, Perry W.
AU - Schwarz, Julie K.
AU - Chundury, Anupama
N1 - Funding Information:
This phase I clinical trial was supported by an institutional grant from the Department of Radiation Oncology at Washington University School of Medicine. Disclosures: L.E.H. reports personal fees from ViewRay, Inc., andgrants and other from Varian Medical Systems, outside the submitted work. C.R. reports grants, personal fees, and other from Varian Medical Systems, grants from Elekta, and other from Astra Zeneca, ViewRay, EMD Serono, and Radialogica, outside the submitted work. O.L.G. reports personal fees from ViewRay, Inc., outside the submitted work. P.T. reports grants and personal fees from Tesaro, grants and personal fees from Merck, personal fees and nonfinancial support from Celsion, and personal fees from Clovis Oncology, Iovance, Abbvie, Stryker, Astra Zeneca, and Immunogen, outside the submitted work.
Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2022/2/1
Y1 - 2022/2/1
N2 - Purpose: Stereotactic body radiation therapy is increasingly used to treat a variety of oligometastatic histologies, but few data exist for ovarian cancer. Ablative stereotactic body radiation therapy dosing is challenging in sites like the abdomen, pelvis, and central thorax due to proximity and motion of organs at risk. A novel radiation delivery method, stereotactic magnetic-resonance–guided online-adaptive radiation therapy (SMART), may improve the therapeutic index of stereotactic body radiation therapy through enhanced soft-tissue visualization, real-time nonionizing imaging, and ability to adapt to the anatomy-of-the-day, with the goal of producing systemic-therapy–free intervals. This phase I trial assessed feasibility, safety, and dosimetric advantage of SMART to treat ovarian oligometastases. Methods and Materials: Ten patients with recurrent oligometastatic ovarian cancer underwent SMART for oligometastasis ablation. Initial plans prescribed 35 Gy/5 fractions with goal 95% planning target volume coverage by 95% of prescription, with dose escalation permitted, subject to strict organ-at-risk dose constraints. Daily adaptive planning was used to protect organs-at-risk and/or increase target dose. Feasibility (successful delivery of >80% of fractions in the first on-table attempt) and safety of this approach was evaluated, in addition to efficacy, survival metrics, quality-of-life, prospective timing and dosimetric outcomes. Results: Ten women with seventeen ovarian oligometastases were treated with SMART, and 100% of treatment fractions were successfully delivered. Online adaptive plans were selected at time of treatment for 58% of fractions, due to initial plan violation of organs-at-risk constraints (84% of adapted fractions) or observed opportunity for planning target volume dose escalation (16% of adapted fractions), with a median on-table time of 64 minutes. A single Grade ≥3 acute (within 6 months of SMART) treatment-related toxicity (duodenal ulcer) was observed. Local control at 3 months was 94%; median progression-free survival was 10.9 months. Median Kaplan-Meier estimated systemic-therapy–free survival after radiation completion was 11.5 months, with concomitant quality-of-life improvements. Conclusions: SMART is feasible and safe for high-dose radiation therapy ablation of ovarian oligometastases of the abdomen, pelvis, and central thorax with minimal toxicity, high rates of local control, and prolonged systemic-therapy–free survival translating into improved quality-of-life.
AB - Purpose: Stereotactic body radiation therapy is increasingly used to treat a variety of oligometastatic histologies, but few data exist for ovarian cancer. Ablative stereotactic body radiation therapy dosing is challenging in sites like the abdomen, pelvis, and central thorax due to proximity and motion of organs at risk. A novel radiation delivery method, stereotactic magnetic-resonance–guided online-adaptive radiation therapy (SMART), may improve the therapeutic index of stereotactic body radiation therapy through enhanced soft-tissue visualization, real-time nonionizing imaging, and ability to adapt to the anatomy-of-the-day, with the goal of producing systemic-therapy–free intervals. This phase I trial assessed feasibility, safety, and dosimetric advantage of SMART to treat ovarian oligometastases. Methods and Materials: Ten patients with recurrent oligometastatic ovarian cancer underwent SMART for oligometastasis ablation. Initial plans prescribed 35 Gy/5 fractions with goal 95% planning target volume coverage by 95% of prescription, with dose escalation permitted, subject to strict organ-at-risk dose constraints. Daily adaptive planning was used to protect organs-at-risk and/or increase target dose. Feasibility (successful delivery of >80% of fractions in the first on-table attempt) and safety of this approach was evaluated, in addition to efficacy, survival metrics, quality-of-life, prospective timing and dosimetric outcomes. Results: Ten women with seventeen ovarian oligometastases were treated with SMART, and 100% of treatment fractions were successfully delivered. Online adaptive plans were selected at time of treatment for 58% of fractions, due to initial plan violation of organs-at-risk constraints (84% of adapted fractions) or observed opportunity for planning target volume dose escalation (16% of adapted fractions), with a median on-table time of 64 minutes. A single Grade ≥3 acute (within 6 months of SMART) treatment-related toxicity (duodenal ulcer) was observed. Local control at 3 months was 94%; median progression-free survival was 10.9 months. Median Kaplan-Meier estimated systemic-therapy–free survival after radiation completion was 11.5 months, with concomitant quality-of-life improvements. Conclusions: SMART is feasible and safe for high-dose radiation therapy ablation of ovarian oligometastases of the abdomen, pelvis, and central thorax with minimal toxicity, high rates of local control, and prolonged systemic-therapy–free survival translating into improved quality-of-life.
UR - http://www.scopus.com/inward/record.url?scp=85116855995&partnerID=8YFLogxK
U2 - 10.1016/j.ijrobp.2021.08.033
DO - 10.1016/j.ijrobp.2021.08.033
M3 - Article
C2 - 34474109
AN - SCOPUS:85116855995
SN - 0360-3016
VL - 112
SP - 379
EP - 389
JO - International Journal of Radiation Oncology Biology Physics
JF - International Journal of Radiation Oncology Biology Physics
IS - 2
ER -